Annals for Educators - July 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesJuly 2023Annals for Educators - July 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202307180 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsTime-Restricted Eating Without Calorie Counting for Weight Loss in a Racially Diverse Population. A Randomized Controlled TrialTime-Restricted Eating for Treatment of Obesity? The Devil Is in the (Counseling) DetailsTime-restricted eating without calorie counting has become a popular weight loss strategy, but long-term randomized trials evaluating its efficacy are limited. This randomized clinical trial examined the effect on weight loss at 12 months of an 8-hour time-restricted eating strategy (without caloric restriction) versus a strategy focused on reducing calories. The accompanying editorial discusses the findings, the important role of counseling in any weight loss intervention, and evidence gaps in what we know about the effectiveness of time-restricted eating.Use this article and the editorial to:Review the difference between randomized controlled trials and observational studies. Discuss the advantages and challenges of conducting trials of dietary interventions.Review the definitions of overweight and obesity.Discuss the disadvantages of using body mass index to define overweight and obesity. This editorial can assist with the discussion. Ask your learners whether the differences in outcomes between groups are clinically significant.Ask your learners to speculate on the potential mechanism of action of time-restricted eating.Effect of Low-Dose Aspirin Versus Placebo on Incidence of Anemia in the Elderly. A Secondary Analysis of the Aspirin in Reducing Events in the Elderly TrialIn this large primary prevention trial in community-dwelling persons aged 70 years or older, daily low-dose aspirin increased the risk for incident anemia by approximately 20%. These findings call into question preventive use of aspirin in older patients and suggest that caution is warranted with this practice.Use this article to:Review the indications for using aspirin for primary and secondary prevention of disease.Review the contraindications to using aspirin for prevention.Ask your learners whether these findings warrant screening for anemia in asymptomatic older patients taking aspirin for prevention.Ask your learners how they would evaluate and manage anemia if it were detected in an asymptomatic patient using aspirin for prevention. Would they approach patient care differently on the basis of whether aspirin was for primary or secondary prevention?Clinical Characteristics and Outcomes Among Travelers With Severe Dengue. A GeoSentinel AnalysisIn this retrospective review of travel-associated dengue reported to the GeoSentinel surveillance platform, complicated dengue occurred in 95 of 5958 (2%) patients. The most common laboratory findings and signs were thrombocytopenia, elevated aminotransferase levels, bleeding, and plasma leakage. Clinicians should monitor patients with dengue for warning signs that may indicate progression to severe disease.Use this article to:Review the epidemiology and clinical presentation of dengue.Discuss preventive strategies for persons traveling to areas where dengue and other mosquito-borne illnesses are endemic. This In the Clinic review can help guide the discussion. Ask your learners how they would identify and manage a patient with suspected dengue.Indefinite Anticoagulant Therapy for First Unprovoked Venous Thromboembolism. A Cost-Effectiveness StudyWhen a patient has unprovoked venous thromboembolism, clinical guidelines recommend 3 to 6 months of anticoagulation. Most also recommend that anticoagulation be continued indefinitely even though the evidence for this strategy is weak. This article compares the benefits, harms, and costs of indefinite anticoagulation versus stopping anticoagulation after the initial treatment.Use this article to:Review the diagnosis and management of deep venous thrombosis. This In the Clinic review can help guide the discussion. Review the factors that clinicians should look for when critically assessing a modeling study. This article can help guide the discussion. Ask your learners to delineate factors that differentiate provoked from unprovoked venous thromboembolism.Ask your learners to list the potential benefits and harms of indefinite anticoagulation. Given the findings of this analysis, would they continue anticoagulation beyond 3 to 6 months?Demonstration Project of Long-Acting Antiretroviral Therapy in a Diverse Population of People With HIVHit Me With Your Best Shot: Long-Acting Therapies to Improve HIV Viral SuppressionThis article presents updated outcomes from a demonstration project of long-acting injectable antiretroviral therapy among patients with HIV and viral suppression who desired to switch from oral therapy and had barriers to adherence that precluded successful oral therapy. The authors of the accompanying editorial discuss the findings, advocate for consideration of long-acting injectable therapy for all patients with HIV, and challenge us to invest in care models that prioritize the most vulnerable people.Use this article and the editorial to:Invite an infectious diseases specialist to review the current treatment options for persons with HIV infection.Discuss the recommended monitoring for patients using antiretroviral therapy for HIV infection.Review the adverse consequences of suboptimal adherence to HIV therapy.Based on the findings of this study, ask your learners if they agree with the editorialists that long-acting injectable therapy should be made available to all patients with HIV infection.COVID-19 Is No Longer a Public Health Emergency: Implications for Patients and CliniciansThis article summarizes the ACP/Annals COVID-19 Forum held on 19 May 2023.Use this article to:Watch the video of the program with your learners.Stop the video at the presentation of each clinical scenario and ask your learners how they would approach the situation.Review the definitions of public health emergency, pandemic, and endemic.Ask your learners whether they would self-test for COVID-19 if they developed upper respiratory symptoms. How would they advise a patient with upper respiratory symptoms?Review the indications for Paxlovid and the processes for prescribing it.If your institution does not have a universal masking policy, ask your learners under what circumstances they would wear a mask in a clinical setting.ProfessionalismUnjust Discrimination Between Cisgender and Transgender Gender-Affirming CareSeveral U.S. states have sought to prohibit gender-affirming medical care for transgender and gender-diverse people. In this commentary, the authors show the discrimination embedded in these laws by highlighting 2 examples of widely accepted gender-affirming care practices routinely provided to cisgender patients that are similar in their goals and methods to transgender care.Use this article to:Review the American College of Physicians' policy position on care of LGBTQ persons. Discuss whether there is existing or proposed legislation prohibiting gender-affirming medical care in the state where your learners practice.Review the care of transgender patients. This In the Clinic review can guide the discussion. Have your learners discuss and debate the position presented in this commentary. Do they agree that prohibiting gender-affirming medical care for transgender and gender-diverse people is discriminatory?Atrial FibrillationEvidence for diagnosis and treatment of atrial fibrillation has expanded substantially since 2017, when In the Clinic last considered this subject. Direct oral anticoagulants have become the predominant therapy for thromboembolic disease, and antidotes for these drugs are now available. Device-based left atrial appendage occlusion is frequently used in patients who cannot tolerate systemic anticoagulation, and growing evidence suggests that early rhythm control improves outcomes. Catheter ablation is now frequently performed to prevent recurrent atrial fibrillation. Managing risk factors for atrial fibrillation, such as hypertension, diabetes, and obesity, remains paramount in prevention of this condition.Use this article to:Review the clinical presentations of atrial fibrillation.Ask your learners to list factors associated with increased risk for atrial fibrillation.Review the options for anticoagulation for patients with atrial fibrillation and how to choose from among the options.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers. Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Christine Laine, MD, MPHFrom the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics July 2023Volume 176, Issue 7 ePublished: 18 July 2023 Issue Published: July 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...